Method and apparatus for closing wounds without sutures

CROSS REFERENCE TO RELATED APPLICATION

0001This application claims priority as a continuation type application under 35 U.S.C. §120 to U.S. patent application Ser. No. 10/412,967, filed Apr. 14, 2003, currently pending. The aforementioned application is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

00021. Field of the Invention

0003The disclosure of this application relates to a method and device for closing wounds or incisions without the use of invasive surgical procedures.

00042. Background

0005The most common methods for closing wounds caused by lacerations or surgical incisions are suturing and stapling. Both of these procedures are skin invasive, which can traumatize and compromise the integrity of the wound. They increase the possibility of infection, expose the surgeon, as well as the patient to blood borne disease, leave behind scar tracks and require a follow-up visit for suture or staple removal.

0006As is well known, a cut that invades deeply into the tissue of the skin generally requires a mechanism for drawing the sides of a wound together to promote healing and to reduce the formation of scar tissue. Surgeons have become skilled in the various techniques of suturing to minimize the resulting blemish that occurs during the healing process. These methods have always generated issues of sterilization and the very nature of suturing requires a threshold of dexterity that escapes many care providers. This is particularly true in emergency situations, which call for immediate treatment to secure the wound for transport or until such time as proper surgery is available. Suturing, even by a skilled surgeon, punctures and stresses skin tissue causing scaring. It is well recognized that a sutureless wound closure would be a great benefit in many situations.

0007Beginning early in the 20th century, attempts were made to provide non-invasive closures. An early example of this is described in U.S. Pat. No. 1,074,413 (1913), which teaches the use of a pair of strips of fabric having adhesive backing. The strips of fabric are applied in parallel on either side of the wound and are constructed with threads extending transversely to bridge the wound. A compressive force is applied across the wound by tying opposing ends of the transverse threads of adjacent strips. In order to maintain the threads in an orderly fashion prior to use, another strip of fabric is attached to the distal ends of the threads to secure the thread ends in parallel for packaging and applying the closure. In one embodiment the threads are woven into both of the strips and then cut after placement of the strips on either side of the wound.

0008Another early device is described in U.S. Pat. No. 1,230,444 (1917). This is a woven fabric adhesive element having a gap intermittently formed in the length of the strip. The gap is formed in the weaving process by omitting weft strands (parallel to the length of the strip) in the gap and reducing the number of warp threads (transverse to the length of the strip) in the gap. A limited number of warp threads, therefore, bridge the gap. An advantage of this device is that it may be constructed in continuous lengths and packaged in a roll for convenient storage. A disadvantage is that the ability to apply a cross-wound force would be limited.

0009A more sophisticated approach is described in the reference Flynn, U.S. Pat. No. 2,196,296 (1940), in which a closure is designed for the express purpose of eliminating suturing. This device illustrates an early step in a trend towards interlocking multiple element devices. Dual adhesive strips are connected to a base adhesive element and to each other by threads woven through eyelets in the base element. The base element is applied to one side of the wound edge and one of the adhesive strips is applied to the other side. A cross wound force can be applied and held by drawing the threads through the eyes and pulling the remaining pair of adhesive strips away from the wound and attaching them to the skin beyond the associated counter part. The construction and assembly of this device is necessarily complex. It employs dual adhesive strips, i.e., the base strip and one of the adhesive strips applied in parallel on either side of the wound, but uses a third adhesive strip to generate and maintain the wound closing force.

0010U.S. Pat. No. 4,423,731 (1984) describes a suture-less wound closure which is similar to that shown in the above cited '413 patent. In this patent the distal ends of the bridging threads of one adhesive strip are interconnected by a further pulling strip which allows the bridging threads to be manipulated in concert. This configuration requires that the bridging threads or filaments of each of the adhesive strips be interlaced to enable the pulling strips to be pulled across the wound and secured. Dual adhesive strips are constructed with bridging filaments interlaced and attached to a pulling strip also having adhesive. The adhesive strips are applied on either side of the wound and are drawn together by grasping the pulling strips and thereby drawing the edges of the wound together. The closure is secured by adhering the pulling strip to the skin on the outer side of the opposing adhesive strip. Opposing forces can be applied simultaneously to each of the adhesive strips at the wound edge to close the wound.

0011The suture-less closure of U.S. Pat. No. 5,263,970 (1993) operates similarly to the closure of the '731 patent. It is however, formed of a single adhesive element which is placed over the wound. Centrally located over the wound opening, there are constructed dual sets of separated elongated extensions. The distal ends of each set of extensions are attached by a laterally extending tab portion. By manipulating the tabs, each set of extensions may be independently manipulated to allow the wound edges to be pulled together or otherwise advantageously moved. The closure is secured by adhering the tabs to adhesive pads on the exposed surface of the adhesive element.

0012An interlocked assembly of adhesive pads are assembled in the system of U.S. Pat. No. 5,534,010 (1996) to be operated in a manner similar to the '731 patent discussed above. First and second pads are adapted for application to the skin on either side of the wound. A third and fourth pad are adapted to adhere to the upper side of the first and second pads respectively. The third pad is attached by bridging filaments to the first pad and may be applied to the upper side of the second pad and the fourth pad is attached by bridging filaments to the second pad and may be applied to the upper side of the first pad.

0013In the bandage of U.S. Pat. No. 6,329,564 (2001), a two component interlocked system is devised which operates similarly to the system of the '010 patent. First and second adhesive strips are constructed with elongated connectors extending transverse to bridge the wound. The connectors are in turn interconnected by a pulling element. The adhesive strips, connectors, and pulling elements are interlaced so the connectors of one adhesive strip extend over the outer surface of the opposing adhesive strip. Similarly to the assembly discussed above opposing forces maybe applied to draw each of the adhesive strips toward each other and thereby close the wound.

0014All of the above bandage configurations, in particular the interlocked dual element style, appear to be difficult to manufacture and to use. The manipulation of a loose assembly of multiple parts in an emergency and possibly life-threatening situation is a challenging undertaking. It is a purpose of this invention to provide a suture-less wound closure which is more easily manufactured and packaged. It is another purpose of this invention to provide a wound closure which is easy to unpackage and apply.

0015The above cited prior art is consistent in several respects, namely, that two adhesive strips need to be provided for application to either side of the wound and that a mechanism is needed to apply forces to each of the adhesive strips to draw them together to close the wound. The prior art seems to solve this need by proposing multiple interlaced parts.

0016It is a purpose of this invention to construct a suture-less wound closing device in one piece that can be used on both sides of a wound without the need for interlacing the parts during manufacture. It is a purpose of this invention to provide a single element wound closure that does not require suturing, stapling or gluing.

0017A simple one piece closure is historically represented by the STERI-STRIP® adhesive strip available from 3M Corporation or butterfly shaped adhesive strips both of which are used to bridge the wound. These configurations may be used singly, in pairs, or multiple units to apply a closing force to the wound. A more complex version of such wound closures is shown in U.S. Patent Application, Pub. No. 2002/0099315, which was published Jul. 25, 2002. A substantially more complex version of this type of closure is described in U.S. Pat. No. 6,293,281 (2001).

0018A purpose of this invention is to simplify, improve upon, and facilitate the customization capability of these various adhesive strips, wound closure devices and methods. A purpose is to provide a simplified elemental device capable of applying a series of adhesive bandage strips that can be used to close wounds and can be adapted to a variety of surgical needs, incision sizes, and types of wounds. It is a further purpose of this invention to provide a closure that does not require any particular dexterity, skill, or knowledge and is reasonable in cost so that it can be used by anyone.

0019In the course of describing this invention below, the bottom of the closing device of this invention will refer to the surface that is intended to engage the skin and the upper side or top will refer to the side of a component that is facing away from the skin after application. Directions will be indicated according to the position of the wound being treated, for example, transverse shall refer to directions across the wound. The inner edge of the closing device shall refer to the side which is intended to be adjacent to the wound lip and the outer edge shall refer to the side of the device that is intended to be away from the wound.

SUMMARY OF THE INVENTION

0020The main element of this invention comprises an elongated flexible base strip having its bottom surface coated with an adhesive material suitable for adherence to skin. The base strip is constructed with bridging links which are spaced along the inner edge of the base strip and extend outward therefrom. The inner edge of the base strip, from which the links extend, is intended to be aligned with a lip of the wound being treated. Each of the bridging links has an adhesive coated section displaced from the inner edge. In the packaged or stored position, prior to engagement, the bridging links are folded over the upper surface of the adhesive strip about a hinge that is at the joint of the bridging link to the base strip. The base strip may be of an extended length so that it might be customized to size and shape of the wound.

0021In order to package the closure device of this invention, protective tapes may be positioned over exposed adhesive material to preserve the adhesive characteristics and avoid undesirable sticking to packaging materials surgical gloves, and other non-designated areas surrounding the wound. To facilitate positioning of the closure device, the protective tape covering the bottom surface may be constructed to expose a region of the adhesive which is immediately adjacent to the inner edge. This inner edge region of adhesive permits the practitioner to apply the base strip without fully engaging the entire adhesive area. The inner edge of the base strip may then be adjusted into alignment with the edge of the wound. After alignment with the wound, the remaining protective tape is removed and the entire base strip is secured adjacent to the wound.

0022In the stored position the adhesive sections of the bridging links will be exposed on the top surface of the links. A protective tape is applied to cover these adhesive sections.

0023In operation the wound will be examined and two substantially equal lengths of the base strip will be cut, torn, or separated from the packaged closure device. In many instances, the contour of the wound will need to be manipulated to form a substantially straight lip to facilitate alignment of the inner edge of the base strip. The inner edge of each length of the base strip is positioned on opposite sides of the wound. The base strip is adjusted to insure that the bridging links on one side of the wound are displaced from the bridging links on the other. To close the wound the bridging links are manually pivoted about a hinge from their stored position and pulled transverse to the wound lip to close the wound. The closing force is maintained by engaging the adhesive section of the bridging links to the upper surface of the opposite length of base strip across the wound.

BRIEF DESCRIPTION OF THE DRAWINGS

0024The invention will be described in more detail below with reference to the attached drawings in which:

0025<figref idref="DRAWINGS">FIG. 1</figref> is a perspective view of a closure device of this invention from the bottom with a first embodiment of protective tapes exploded;

0026<figref idref="DRAWINGS">FIG. 2</figref> is a perspective view of a closure device of this invention from the top, with a second embodiment of protective tapes exploded;

0027<figref idref="DRAWINGS">FIG. 3</figref> is a perspective view of a closure device of this invention from the top, with a third embodiment of protective tapes exploded;

0028<figref idref="DRAWINGS">FIG. 4</figref> is a perspective view of a closure device of this invention from the top, with a forth embodiment of protective tapes exploded;

0029<figref idref="DRAWINGS">FIG. 5</figref> is a perspective view of a closure device of this invention from the top, with aligned lengths of base strips applied to a wound;

0030<figref idref="DRAWINGS">FIG. 6</figref> is a perspective view of a closure device of this invention from the top, with some of the bridging links engaged;

0031<figref idref="DRAWINGS">FIG. 7</figref> is a perspective view of a closure device of this invention from the top, in the completely engaged condition;

0032<figref idref="DRAWINGS">FIG. 8</figref> is a perspective view of an alternate embodiment of the closure device of this invention from the top;

0033<figref idref="DRAWINGS">FIG. 9</figref> is a perspective view of an alternate embodiment of the closure device of this invention from the top with aligned lengths of the base strip applied to the wound;

0034<figref idref="DRAWINGS">FIG. 10</figref> is a perspective view of an alternate embodiment of the closure device of this invention from the top in a fully engaged condition;

0035<figref idref="DRAWINGS">FIG. 11</figref> is a perspective view of an alternate embodiment of the invention with the engaging adhesive section resident on both the base strip and the bridging links;

0036<figref idref="DRAWINGS">FIG. 12</figref> is a perspective view of an alternate embodiment of the invention with the adhesive section for engaging the bridging links only resident on the base strip;

0037<figref idref="DRAWINGS">FIG. 13</figref> is a perspective view of the embodiment of <figref idref="DRAWINGS">FIGS. 9 and 10</figref> with the engaging adhesive resident on both the base strip and the bridging links; and

0038<figref idref="DRAWINGS">FIG. 14</figref> is a perspective view of the embodiment of <figref idref="DRAWINGS">FIGS. 9 and 10</figref> with the engaging adhesive on the base strip only.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

0039The invention of this application involves a single component wound closure which is easy to manufacture and simple to use. It is useable to reliably close a wide variety of wound openings, large and small. It is designed for ease of use in any environment, whether it is a field emergency or an in hospital surgical procedure. It employs the basic concept of providing a single component surgical strip which can be used on both sides of the wound and avoids the difficulties of complex interlaced multiple component bandages.

0040As shown in <figref idref="DRAWINGS">FIGS. 1-8</figref>, an elongated flexible base strip <b>1</b> forms the main element of this invention and is constructed having its bottom surface <b>2</b> coated with an adhesive material <b>3</b> suitable for adherence to skin <b>4</b> (<figref idref="DRAWINGS">FIG. 5</figref>). As shown in <figref idref="DRAWINGS">FIG. 2</figref>, base strip <b>1</b> is constructed with multiple bridging links <b>5</b> that extend generally transverse to the base strip <b>1</b>. The links <b>5</b> are spaced along the inner edge <b>6</b> of the base strip <b>1</b> and extend outward therefrom. The inner edge <b>6</b> of the base strip <b>1</b>, from which the links <b>5</b> extend, is intended to be aligned with a lip <b>7</b> of the wound <b>8</b> being treated, as shown in <figref idref="DRAWINGS">FIG. 5</figref>. Each of the bridging links <b>5</b> has an adhesive coated section <b>9</b>, on its bottom (engaging) surface <b>18</b>, displaced from the inner edge <b>6</b>.

0041In an alternative embodiment, as shown in <figref idref="DRAWINGS">FIGS. 11 and 13</figref>, an additional adhesive coated section <b>30</b> (<b>130</b> in <figref idref="DRAWINGS">FIG. 13</figref>) is coated on both the top surface <b>12</b> of the base strip <b>1</b> (<b>112</b> in <figref idref="DRAWINGS">FIG. 13</figref>) and the engaging surface <b>18</b> (<b>118</b> in <figref idref="DRAWINGS">FIG. 13</figref>) of the bridging links <b>5</b> (<b>105</b> in <figref idref="DRAWINGS">FIG. 13</figref>).

0042In another alternative embodiment, as shown in <figref idref="DRAWINGS">FIGS. 12 and 14</figref>, the adhesive coated section <b>9</b> is absent from bridging links <b>5</b> and an adhesive section <b>30</b> (<b>130</b> in <figref idref="DRAWINGS">FIG. 14</figref>) is applied to top surface <b>12</b> (<b>112</b> in <figref idref="DRAWINGS">FIG. 14</figref>) of base strip <b>1</b>. Adhesive sections <b>30</b> (<b>130</b>) receive the engaging surface <b>18</b> (<b>118</b> in <figref idref="DRAWINGS">FIG. 14</figref>) of each bridging link <b>5</b> (<b>105</b>) and hold the links <b>5</b> (<b>105</b>) securely in their bridging position.

0043The base strip <b>1</b> and its associated bridging links <b>5</b> may be constructed by stamping from a single elongated sheet of plastic material. Alternatively molding or extruding processes may be advantageously used. In some circumstances, it may be advantageous to stiffen the bridging links to facilitate handling. The bridging links may be made more rigid by laying up a second or third layer of plastic sheet material or by otherwise thickening the plastic material in the area of the bridging links <b>5</b>, as shown in <figref idref="DRAWINGS">FIG. 2</figref>.

0044In the packaged or stored position, as shown in <figref idref="DRAWINGS">FIGS. 1 and 2</figref>, the bridging links <b>5</b> are folded over the upper surface <b>12</b> of the adhesive base strip <b>1</b> about a hinge <b>10</b> that is at the joint of the bridging links and base strip <b>1</b>. Hinge <b>10</b> may be a hinge region formed to provide increased flexibility where bridging links <b>5</b> are joined to the base strip. As shown, no adhesive is applied to the hinge region.

0045As shown in <figref idref="DRAWINGS">FIG. 6</figref>, a small amount of adhesive <b>11</b> can be used on the upper surface <b>12</b> of the base strip <b>1</b> to engage each of the folded bridging links <b>5</b> and releasably hold them in a stored position, see <figref idref="DRAWINGS">FIGS. 1-4</figref>. The base strip <b>1</b> may be of an extended length so that it might be cut, torn, or otherwise separated to the desired size, depending on the wound. It could also be packaged in a rolled configuration <b>13</b> as shown in <figref idref="DRAWINGS">FIGS. 3 and 4</figref> and separated as needed.

0046Folding the bridging links <b>5</b> provides an uncluttered operating edge with which to properly align base strip <b>1</b> with the wound lip <b>7</b>.

0047In order to package the closure device of this invention, protective tapes, such as <b>14</b>, <b>15</b>, and <b>16</b> shown in <figref idref="DRAWINGS">FIG. 1</figref>, may be positioned over exposed adhesive materials <b>3</b> and <b>9</b>. Protective tapes <b>14</b>, <b>15</b> and <b>16</b> act to preserve the adhesive characteristics while helping to avoid undesirable, sticking to packaging materials and other areas surrounding the wound.

0048To facilitate positioning of the closure device, protective tape covering the bottom surface <b>3</b> may be constructed in two parts a main part <b>14</b> and an edge part <b>15</b>. The edge part <b>15</b> of the protective tape is aligned with the inner edge <b>6</b> of the base strip <b>1</b> and is of limited width. This allows the initial exposure of a limited edge adhesive surface <b>19</b>. This in turn allows the base strip <b>1</b> to be aligned with the wound <b>8</b> and adjusted prior to adhering the entire base strip <b>1</b> adjacent to the wound <b>8</b>.

0049In the stored position, the adhesive sections <b>9</b> of the bridging links <b>5</b> will be exposed as shown in <figref idref="DRAWINGS">FIGS. 1-4</figref>. A protective tape <b>16</b> is applied to cover the adhesive sections <b>9</b>. To assist the user in applying the closure, each of the tape elements may be color coded or otherwise identified to indicate the order of removal. For example: in the removal of the parts <b>14</b> and <b>15</b> of the bottom protective tape, and the top protective tape <b>16</b>, different colors or transparency tints may be used. Alternatively, the parts may be numbered or otherwise labeled to indicate the order of removal.

0050In an alternative embodiment, as shown in <figref idref="DRAWINGS">FIG. 2</figref>, the protective tape <b>14</b><i>a </i>is formed in one piece having a fold or perforated line <b>20</b> constructed a distance outward from the inner edge <b>6</b> and extending the length of the edge <b>6</b>. By partially removing the tape <b>14</b><i>a </i>up to the fold line <b>20</b>, the limited edge adhesive <b>19</b><i>a </i>may be exposed to accomplish the same purpose as indicated above.

0051In another alternative embodiment, as shown in <figref idref="DRAWINGS">FIG. 3</figref>, edge adhesive <b>19</b><i>c </i>is defined by limiting the width of tape <b>14</b><i>c </i>to leave the edge adhesive <b>19</b><i>c </i>exposed. The edge adhesive is covered in this embodiment only by the exterior packaging sheet <b>21</b>. In the further alternative embodiment of this invention, as shown in <figref idref="DRAWINGS">FIG. 4</figref>, the protective tapes <b>14</b> and <b>15</b> are eliminated and the exterior packaging sheet <b>21</b> provides the necessary protection from exposure.

0052To complete the packaging of the closure device of this invention, a tear away outer package, constructed of appropriate sheet material <b>21</b> is used to provide an overall sterile wrap for the closure, as is well known. In some situations wrap <b>21</b> can be used to protect exposed adhesive sections, if no protective tapes are used. An overall wrap <b>21</b> surrounds the closure device and is edge sealed to maintain sterile conditions. When packaged in an extended length such as a roll, a variety of lengths of base strip <b>1</b> may be precut and contained in sealed segments of wrap <b>21</b> or means may be provided to create an edge seal at the cut edge of a packaged closure which is of continuous length.

0053A typical wound <b>8</b> caused by a laceration or surgical incision is shown in <figref idref="DRAWINGS">FIG. 5</figref> having a lip <b>7</b> at the edge of the gap <b>22</b>. Before the closure of this invention is applied, the wound <b>8</b> is examined to determine the length L of wound <b>8</b>. The base strip is then cut to a length L+ which is slightly longer than wound <b>8</b>. Two approximately equal lengths <b>1</b><i>a </i>and <b>1</b><i>b </i>of the base strip <b>1</b> are cut, torn or otherwise separated from the packaged closure device, as for example roll <b>13</b>. After removing the outer wrap <b>21</b>, edge protective tape <b>15</b> is removed to expose adhesive edge <b>19</b>. In many instances the wound lip <b>7</b> will be curvilinear or otherwise of irregular shape because of natural skin tension or the nature of the injury. This may require manipulation of the skin surrounding the wound to bring the lip <b>7</b> into a substantially straight form to accommodate the straight edge <b>6</b> of base strip <b>1</b>.

0054The inner edges <b>6</b><i>a </i>and <b>6</b><i>b </i>of each length of the base strips <b>1</b><i>a </i>and <b>1</b><i>b </i>are positioned adjacent the lip <b>7</b> of the wound <b>8</b>. Base strips <b>1</b><i>a </i>and <b>1</b><i>b </i>are adjusted to insure that the bridging links <b>5</b><i>a </i>on one side of the wound <b>8</b> are displaced from the bridging links <b>5</b><i>b </i>on the other side, as shown by arrows x and y in <figref idref="DRAWINGS">FIG. 5</figref>. At this point the remaining part <b>14</b> of protective tape is removed and the base strips <b>1</b><i>a </i>and <b>1</b><i>b </i>are secured to the skin in place adjacent to the wound. Protective tape <b>16</b> may then be removed to expose adhesive sections <b>9</b>.

0055As shown in <figref idref="DRAWINGS">FIGS. 5 and 6</figref>, to close the gap <b>22</b> of wound <b>8</b>, the bridging links <b>5</b><i>a </i>and <b>5</b><i>b </i>are manually pivoted from their stored position and pulled transverse to the wound lip <b>7</b>.

0056By simultaneously exerting a force F on pairs of adjacent bridging links <b>5</b><i>a </i>and <b>5</b><i>b </i>from opposing sides of the wound, the base strips <b>1</b><i>a </i>and <b>1</b><i>b </i>and the wound lip <b>7</b> will be drawn together to close gap <b>22</b>, as shown in <figref idref="DRAWINGS">FIG. 6</figref>. The space G between the inner edges <b>6</b><i>a </i>and <b>6</b><i>b </i>of the lengths <b>1</b><i>a </i>and <b>1</b><i>b</i>, shown in <figref idref="DRAWINGS">FIGS. 5 and 6</figref>, is reduced during this process. It is advantageous to adjust the position of the operating edges <b>6</b> so that a small separation G′ remains after the wound is closed. This will leave room for the emission of exudates from the wound, while also providing access for the delivery of medication. The closing force is maintained by engaging the adhesive section <b>9</b> of the bridging links <b>5</b><i>a </i>and <b>5</b><i>b </i>to the upper surface <b>12</b> of the opposite length of base strip <b>1</b> across the wound <b>8</b>. The bridging links <b>5</b><i>a </i>and <b>5</b><i>b </i>are thus applied until the wound is closed and secure, as shown in <figref idref="DRAWINGS">FIG. 7</figref>. To provide an uncluttered overall wound dressing, the excess portions of bridging links <b>5</b> may be trimmed by cutting or tearing along perforations <b>31</b> which may be constructed in each link.

0057In this manner a simple closure is constructed which is easier to manufacture and use than the multiple component devices of the prior art.

0058To facilitate the closure of small wounds or partial areas of larger wounds, the adhesive strip may, in the alternative, be constructed as shown in <figref idref="DRAWINGS">FIGS. 8-10</figref>. In this embodiment the components are arranged generally as described before. An elongated adhesive base strip <b>101</b> is formed having multiple bridging links <b>105</b>. The bottom <b>102</b> is coated with an adhesive material. Adhesive sections <b>109</b> are applied to the top surface <b>118</b> of bridging link <b>105</b>. The base strip <b>101</b> may be sealed in sterile packages of various lengths, in rolled configurations <b>113</b>, or other appropriate means.

0059To facilitate use of the strips in short units, the bridging links <b>105</b> are spaced differently. The base strip <b>101</b> is divided, by markings and/or perforated lines <b>140</b>, into operational units <b>141</b> and <b>142</b>. The units <b>141</b> and <b>142</b> are marked off over the entire length of base strip <b>101</b>. A pair <b>143</b> of links <b>105</b> is positioned together with a normal spacing <b>144</b> within the first unit <b>141</b>. The pair <b>143</b> is centered within the unit <b>141</b>. A single link <b>105</b> is then positioned in the center of the adjacent unit <b>142</b>. This arrangement is alternated over the length of the base strip <b>101</b>. To use this alternative embodiment, the base strip <b>101</b> is cut or separated to obtain one operational unit <b>141</b>, having a pair <b>143</b> of bridging links <b>105</b>, and one operational unit <b>142</b>, having a single bridging link <b>105</b>. Operational units <b>141</b> and <b>142</b> are placed on opposite sides of wound <b>108</b>, as shown in <figref idref="DRAWINGS">FIG. 9</figref>. By aligning the units <b>141</b> and <b>142</b>, the bridging links <b>105</b> can be applied without interference, as shown in the secured closure in <figref idref="DRAWINGS">FIG. 9</figref>.

0060It should be understood that the foregoing description is only illustrative of the invention. Various alternatives and modifications can be devised by those skilled in the art without departing from the invention. Accordingly, the present invention is intended to embrace all such alternatives, modifications and variances which fall within the scope of the appended claims.